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The Advocate Oak Blog


Year: 2021

It’s Election Season!

For this upcoming election, NJ is offering an accessible vote-by-mail electronic ballot. Disability Rights NJ recently sponsored a webinar with Democracy Live to demonstrate the accessible vote-by-mail ballot to help individuals with disabilities understand the process and determine whether this option works for them. NJ residents can request an electronic mail-in ballot from their county clerk. The electronic ballot can be read aloud through compatible programs such as JAWS.

After completing the online ballot, it must be printed, and returned in a county-provided envelope through the mail, a ballot drop box, or in person to the county board of elections. The recorded webinar has been linked below and goes in-depth on accessible vote-by-mail.

Please share this information widely to your members so that they are fully aware of their rights to an accessible vote-by-mail ballot.

All forms of voting should be accessible. If you have any questions or issues, please contact Disability Rights NJ at 866-493-0023.

NJ HAS INTRODUCED EARLY VOTING

Early In-Person VotingOctober 23 – October 31

Monday-Saturday: 10 AM-8 PM and Sunday: 10 AM-6 PM

New Jersey has introduced “Early Voting” — you can vote in person at select locations now!

All counties must offer Early Voting locations. Call your county Board of Elections to learn the locations offered, or go to https://nj.gov/state/elections/vote-early-voting.shtml

All early voting locations must be accessible. If a location is not accessible, please contact Disability Rights NJ’s Voter Hotline – 866-493-0023 or [email protected]

Jesse, Rob, and Barbara came together to explain the importance of voting for people with disabilities, and why you should be an early voter! Learn more about early voting and find a polling place or ballot drop box near you at VoteEarlyDay.org

Hear from our own Chris Miller about the importance of voters with disabilities participating in Election Day. As he says “We have power, we have to use it”

2021 Assistive Technology and Community Living Summit Wrapped Up

On September 23 and 24, Disability Rights New Jersey hosted a 2-day event – Assistive Technology and Community Living Summit with over 400 attendees and featured more than 40 workshops for consumers and professions covering a wide variety of topics about assistive technology and community living. 

Each day the Summit highlighted keynote speakers from the assistive technology and community living field.  On Thursday, Denise Ghizzone, author and AAC user spoke about her life with Cerebral Palsy and her dedication to inspire and enable others with disabilities to push through their own obstacles.

On day two, Jennifer Langer Jacobs, Assistant Commissioner, Division of Medical Assistance and Health Services talked about efforts to improve Medicaid home and community-based services.

State-by-State: Better Care Better Jobs Act

Chairman Senator Casey released state-by-state fact sheets demonstrating the positive impact of enacting S. 2210, the Better Care Better Jobs Act, which seeks to expand access to home and community-based services and increase compensation for home care workers. The fact sheets, based on publicly available data and expert analysis, highlight the difference in costs for providing care in the home and in institutional settings, and provide state-level figures illustrating the profound, potential effects of the bill’s passage. Specifically, these state-by-state fact sheets note: 

  • How many people are on wait lists for care; 
  • How many family caregivers could return to work; 
  • How many more seniors and people with disabilities could access care; and
  • How many new home care jobs would be created. 

S. 2210 has the support of over 500 state and national organizations. Based on the latest polling from Data for Progress, more than 3 in 4 Americans support this legislation. 

Please also see a recent New York Times op-ed about the importance of supporting caregivers, which references the Better Care Better Jobs Act.

Justice Department Reaches Agreement with the State of New Jersey under the National Voter Registration Act

The Justice Department announced that it has entered into a proposed consent decree to settle a voting rights lawsuit with the State of New Jersey and state officials.

The Justice Department’s lawsuit, brought under Section 7 of the National Voter Registration Act (NVRA), challenges the failure of disability transportation programs in the State of New Jersey — including NJ Transit Access Link and county-based Community Transportation programs — to provide voter registration opportunities to their customers. 

The proposed consent decree was filed in federal court in conjunction with a lawsuit brought by the Justice Department. The department’s complaint alleges that the State of New Jersey failed to designate offices in the State that provide paratransit and other state-funded disability transportation services as voter registration agencies. Under the NVRA, these offices must distribute a voter registration application to each person who applies for their services, and along with each recertification, renewal or change of address form relating to such services, unless the person involved declines in writing to register to vote. They must also assist applicants in completing voter registration applications, and they must accept completed voter registration applications for transmittal to appropriate state election officials. However, NJ Transit Access Link and Community Transportation programs have not been providing the voter registration opportunities guaranteed by the NVRA. 

“Part of our ongoing effort to ensure access to the ballot includes ensuring that social service and disability agencies are providing registration opportunities as required under federal law,” said Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division. “The National Voter Registration Act is a vital tool to ensure that citizens with disabilities have convenient and accessible opportunities to register to vote. It is critical that all citizens have unfettered access to voter registration opportunities. I am pleased that the State of New Jersey has worked with the Department of Justice to help ensure that citizens with disabilities will have broad access to the voter registration opportunities that federal law guarantees.”

“The right to vote is a constitutional principle that forms a cornerstone of our democracy,” said Acting U.S. Attorney Rachael A. Honig for the District of New Jersey. “The National Voter Registration Act enhances citizens’ access to that democratic process by increasing voter registration opportunities. We appreciate that the State of New Jersey has worked with us to ensure that all New Jersey residents, including those with disabilities, enjoy convenient opportunities to register to vote.”

The department gave notice to the State of New Jersey of its intent to bring suit under the National Voter Registration Act on March 11, 2021, and the parties worked collaboratively to achieve this agreement.  Under the parties’ consent decree — and subject to approval by the federal district court in New Jersey — New Jersey will designate NJ Transit Access Link and Community Transportation as voter registration agencies. New Jersey will also conduct robust implementation and oversight efforts and will afford supplemental voter registration opportunities to existing Access Link clients. 

More information about the National Voter Registration Act and other federal voting rights laws is available on the Department of Justice website at https:www.justice.gov/crt/voting-section. More information about the Civil Rights Division and the laws it enforces is available at http://www.justice.gov/crt

Psychiatric Advance Directives: Empowering Self-Determination in Mental Health Care Decision-Making

by Elena Zoniadis, Managing Attorney

In 2006, the New Jersey Legislature passed the Advance Directives for Mental Health Care Act. N.J.S.A. § 26:2H-102, et seq.Commonly referred to as “Psychiatric Advance Directives” or “PADs,” such directives permit an individual to detail what health care directives should apply if their decision-making capacity is compromised due to “serious illness, injury, or permanent loss of mental capacity.” N.J.S.A. § 26:2H-103(b). Therefore, a PAD is a “springing” legal right, which means that it takes effect at some future time upon some future occurrence.

The benefits of a PAD include self-determination and the avoidance of judicial involvement. Further, PADs allow a representative to make decisions when a guardianship order would be impracticable or inappropriate, as in the case of an episodic condition such as a mood disorder.

The U.S. Supreme Court has held that clear and convincing evidence of a person’s treatment preferences is required in the event of incompetency, and that due process prohibits the state from accepting the substituted judgment of family members absent substantial proof that their decisions reflect those wishes. Cruzan v. Missouri Dep’t of Health, 497 U.S. 261, 271 (1990). The PAD laws follow this legal trend towards self-determination and contain multiple protections. These include: how a “responsible mental health care professional shall determine” lack of capacity (N.J.S.A. § 26:2H-109(a)); what directives may be included (N.J.S.A. § 26:2H-107); instruction when there is no designated representative or if such representative is unable to serve (N.J.S.A. § 26:2H-113); and recognition of PADs properly executed in other jurisdictions (N.J.S.A. § 26:2H-123).

Disability Rights NJ has prepared materials that explain who a PAD might benefit, the scope of a representative, and what decision-making authorizations or restrictions can be included. In addition, we have worked with the Mental Health Association of New Jersey to create PAD templates (with instructions in English and Spanish). The New Jersey Department of Human Services, Division of Mental Health and Addiction Services has contracted with the U.S. Living Will Registry to create a secure centralized PAD registry. Our website also contains information on registering a PAD so that providers can easily locate information regarding an individual’s health care wishes in the event of a mental health crisis.

Important Updates to Guardianship Background Checks

New Jersey Rule Amendment Requires Background Checks for Certain Guardians

By Elena Zoniadis, Managing Attorney, Disability Rights NJ

On March 17, 2021, Glenn A. Grant, J.A.D., Acting Administrative Director of the Courts, issued a
Notice to the Bar regarding Amendments to New Jersey Rule 4:86.  The amendments were ordered by
Chief Justice Stuart Rabner on March 15, 2021 and incorporate background screening policies for certain
proposed guardians.  On April 29, 2021, the Honorable Judge Grant issued Directive #11-21, which
includes revised court forms that comply with the requirements of the amended Rule. The Rule
amendments and related court forms became effective on May 15, 2021.


Pursuant to the revised R. 4:86-2(b)(3), an affidavit or certification must accompany a Guardianship
Complaint, and it must set forth the criminal and civil judgment history of each proposed guardian.  The
court will consider the relevant history provided in the affidavit or certification, as well as review any
background screening established by the Administrative Director of the Courts. R. 4:86-2(b)(3), 4:68-
4(a)(7).


There are presumptive exceptions to the automatic requirements where the proposed guardian:  (A) is in a
“parent and child relationship” (see N.J.S.A. 9:17-39); (B) is either married to the person lacking
capacity, in a civil union with that person, or in a domestic partnership with that person (see N.J.S.A.
37:1-29, N.J.S.A. 37:1-29, N.J.S.A. 26:8A-3); (C) is appointed pendente lite (see N.J.S.A. 3B:12-24.1(c));
(D) is an agency authorized to act pursuant to P.L. 1985, c. 298, P.L. 1965, c. 59, and P.L. 1970, c. 289;
(E) is a public official appointed as a limited guardian for medical purposes for individuals in psychiatric
facilities as listed in R.S. 30:1-7; (F) is a financial institution duly licensed or authorized to conduct
business; and (G) is an attorney admitted to practice law and in good standing in the State or New Jersey.
R. 4:86-2(b)(3)(A)-(H).


Notwithstanding the presumptive exceptions to the rule, in all cases the court may require the proposed
guardian undergo a background screening as a prerequisite to appointment. R. 4:86-2(b).  Amendments to
the Rule do not yet enumerate what criteria a court should employ in determining whether results of a
background check should preclude an individual from serving as a guardian.

Private Equity Owned NJ Residential Facilities Receive Congressional Scrutiny


by Cory Bernstein, Staff Attorney

For several years, Disability Rights New Jersey has been concerned with the quality of care in private equity-owned long-term and residential care settings including nursing homes, psychiatric residential treatment facilities, and group homes.  In the past decade, the enactment of parity laws and expanded state level programs, particularly for behavioral health services, incentivized private equity firms to acquire residential care facilities.[i] Private equity funds make acquisitions through debt-financed purchases, or leveraged buyouts, with the acquisition’s assets placed as collateral for the transaction.[ii] This way, debts are placed on the facility, rather than the firm.[iii] This forces the facility to reduce overhead expenses, such as staffing levels and programming so it is not swallowed by its newfound debt.[iv]Consequently, the private equity firm increases profit at the expense of lower service quality. These practices are consistent across long-term and residential care settings. 

On March 25, 2021, Congressman Bill Pascrell (NJ-09) chaired a House of Representatives Ways and Means Oversight subcommittee hearing on this issue, paying particular attention to New Jersey nursing homes. At the hearing, expert witness testimony detailed how private equity firms obscure and magnify their returns through self-dealing with service providers, such as pharmaceutical suppliers it owns. Milly Silva, a New Jersey United Healthcare workers union leader, explained how private equity’s cost cutting strategies reduces staff support for residents, conversely increasing prescriptions of dangerous antipsychotic medications for elderly populations.[i]  Research presented at the hearing alsoshowed that private equity owned nursing facility residents are 50% more likely to take antipsychotic medications, are billed 11% more, and have a 10% greater mortality rate than Medicare recipients at nursing homes with other organizational structures.[ii]

Since COVID-19, conditions at New Jersey’s private equity owned nursing homes have received national attention, and Disability Rights NJ is currently investigating conditions at these facilities.  Disability Rights NJ will continue its work holding service providers accountable for putting profit over the health and safety of residents.  

[i] Id. at 2; Hearing on Examining Private Equity’s Expanded Role in the U.S. Health Care System: H. Comm. Ways and Means, Subcomm. on Oversight, 117th Cong. (March 25, 2021) (statement of Milly Silva, Executive Vice President, 1199 SEIU United Healthcare Workers East), https://waysandmeans.house.gov/sites/democrats.waysandmeans.house.gov/files/documents/M.%20Silva%20Testimony.pdf.

[ii] Hearing on Examining Private Equity’s Expanded Role in the U.S. Health Care System: H. Comm. Ways and Means, Subcomm. on Oversight, 117th Cong. 2-4, 9 (March 25, 2021) (statement of Sabrina Howell, P.hD., Assistant Professor of Finance, New York University Stern School of Business), https://waysandmeans.house.gov/sites/democrats.waysandmeans.house.gov/files/documents/S.%20Howell%20Testimony.pdf.


[i] See e.g. Bain & Company, Global Healthcare Private Equity and Corporate M&A Report 2020, 4-6, 36 (2020) https://www.bain.com/globalassets/noindex/2020/bain_report_global_healthcare_private_equity_and_corporate_ma_report_2020.pdf.

[ii] Eileen Applebaum & Rosemary Batt, Private Equity: When Wall Street Manages Main Street 24 (2014).

[iii] Hearing on Examining Private Equity’s Expanded Role in the U.S. Health Care System: H. Comm. Ways and Means, Subcomm. on Oversight, 117th Cong. 2-4, 9 (March 25, 2021) (statement of Sabrina Howell, P.hD., Assistant Professor of Finance, New York University Stern School of Business), https://waysandmeans.house.gov/sites/democrats.waysandmeans.house.gov/files/documents/S.%20Howell%20Testimony.pdf.

[iv] IdSee also Eileen Applebaum & Rosemary Batt, Private Equity: When Wall Street Manages Main Street 98 (2014).

On March 25, 2021, Congressman Bill Pascrell (NJ-09) chaired a House of Representatives Ways and Means Oversight subcommittee hearing on this issue, paying particular attention to New Jersey facilities. At the hearing, expert witness testimony detailed how private equity firms obscure and magnify their returns through self-dealing with service providers, such as pharmaceutical suppliers it owns. Milly Silva, a New Jersey United Healthcare workers union leader, explained how private equity’s cost cutting strategies reduces staff support for patients, conversely increasing prescriptions of dangerous antipsychotic medications for elderly populations.[v] Research presented at the hearing also showed that private equity owned nursing facility patients are 50% more likely to take antipsychotic medications, are billed 11% more, and have a 10% greater mortality rate than Medicare recipients at nursing homes with other organizational structures.[vi]

Since COVID-19, conditions at New Jersey’s private equity owned nursing homes have received national attention, and Disability Rights NJ is currently investigating conditions at these facilities. Disability Rights NJ will continue its work holding inpatient service providers accountable for putting profit over patient health and safety.

[1] See e.g. Bain & Company, Global Healthcare Private Equity and Corporate M&A Report 2020, 4-6, 36 (2020) https://www.bain.com/globalassets/noindex/2020/bain_report_global_healthcare_private_equity_and_corporate_ma_report_2020.pdf.

[1] Eileen Applebaum & Rosemary Batt, Private Equity: When Wall Street Manages Main Street 24 (2014).

[1] Hearing on Examining Private Equity’s Expanded Role in the U.S. Health Care System: H. Comm. Ways and Means, Subcomm. on Oversight, 117th Cong. 2-4, 9 (March 25, 2021) (statement of Sabrina Howell, P.hD., Assistant Professor of Finance, New York University Stern School of Business), https://waysandmeans.house.gov/sites/democrats.waysandmeans.house.gov/files/documents/S.%20Howell%20Testimony.pdf.

[1] IdSee also Eileen Applebaum & Rosemary Batt, Private Equity: When Wall Street Manages Main Street 98 (2014).

[1] Id. at 2; Hearing on Examining Private Equity’s Expanded Role in the U.S. Health Care System: H. Comm. Ways and Means, Subcomm. on Oversight, 117th Cong. (March 25, 2021) (statement of Milly Silva, Executive Vice President, 1199 SEIU United Healthcare Workers East), https://waysandmeans.house.gov/sites/democrats.waysandmeans.house.gov/files/documents/M.%20Silva%20Testimony.pdf.

[1] Hearing on Examining Private Equity’s Expanded Role in the U.S. Health Care System: H. Comm. Ways and Means, Subcomm. on Oversight, 117th Cong. 2-4, 9 (March 25, 2021) (statement of Sabrina Howell, P.hD., Assistant Professor of Finance, New York University Stern School of Business), https://waysandmeans.house.gov/sites/democrats.waysandmeans.house.gov/files/documents/S.%20Howell%20Testimony.pdf.